Sonographic Detection of Starry Sky Liver in a Pregnancy With Twin-Twin Transfusion Syndrome

Twin-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies. A starry sky liver is characterized by sonography as liver parenchyma appearing hypoechoic due to swelling of liver cells, accentuating the periportal collagen. It has been associated with several pathological processes but has only recently been reported with TTTS. This case study is a report of a twin pregnancy that developed TTTS in which a starry sky liver was visualized in the recipient twin.